POS0686 GENDER DIFFERENCES IN THE MANAGEMENT OF SPONDYLOARTHRITIS (SPA) PATIENTS
Authors: D. Baldock, M. Thoo, R. Connolly, E. Baynton
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Spondyloarthritis (SpA) is a family of arthritic rheumatic diseases, including axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), that primarily affects the spine and joints. It causes inflammation of the spinal and peripheral joints that can lead to severe, chronic pain and discomfort. Diagnosing SpA has proven challenging, particularly for women who are found to be underdiagnosed in AS despite the disease affecting men and women both equally, as there are no current diagnostic criteria for axSpA <sup>[1]</sup>. Disease activity can be measured through tests such haematology and joint count measurements. <h3>Objectives</h3> The objective of this study was to examine any gender differences in the management of SpA patients and highlight any nuances in treating these patients. <h3>Methods</h3> A multi-centre online medical chart review study of patients with PsA and Axial SpA was conducted between July 2022 – September 2022 among UK, FR, DE, IT &amp; ES rheumatologists practicing across hospital and private practices. Physicians were screened for practice duration and patient volume. Charts of patients prescribed with biologics/tsDMARDS were included in the analysis. <h3>Results</h3> 262 sampled physicians collectively reported 1387 SpA patients. From the reported SpA patients, 812 were recorded as male and 575 as female. The female cohort were recorded with higher instances of co-existing conditions of depression (11.5% vs 5.3%) and anxiety (13.2% vs 8.1%) than men. When evaluating extra articular manifestations, female cohort were recorded with higher nail dystrophy (12.7% vs 8.6%) and psoriasis (36.7% vs 26.4%) than men. In assessing areas the AS patient suffers from, female cohort were recorded with higher peripheral involvement (49.6% vs 34.0%) and males more axial involvement (50.9% vs 28.0%). In assessing disease scores, female cohort were recorded with higher joint counts, haem scores, and PASI score. Physician-defined status of disease severity reported female cohort with higher current severity (48.4% vs 41.5% moderate and severe) and lower remission rates (45.4% vs 36.7% not in remission) in comparison to men. Length of time on current biologic and/or tsDMARD recorded male cohort on treatment for longer timeframe vs females (mean months: 50.2 vs 46.5). The most prominent biologics to treat the two patient groups are TNFis (72.2% male, 68.6% female); alternate modes of action, such as IL-17is and JAKis, are more prominently recorded in females vs males (31.2% vs 27.7%). Drivers of treatment choice – specified by sampled physicians - prioritised efficacy in skin (23.3% vs 19.3%), efficacy in manifestations of PsA beyond skin and joint (13.6% vs 9.6%), and reduction of peripheral joint inflammation (17.0% vs 10.3%) in female cohort versus male cohort. <h3>Conclusion</h3> From the sample surveyed, current disease activity is higher in reported female patients than males in SpA. Additionally, males are more likely to stay on the same bio/tsDMARD versus females, suggesting a disparity in efficacy or unmet needs when evaluating the two cohorts. It is possible that key differentiating identifiers, such as co-existing comorbidities outside axSpA or PsA or extra articular manifestations, can be used when deciding how to treat a patient. Discussion is necessary about gender-specific treatment plans in SpA, as well as factoring in possible mental health burden (anxiety and depression) disparities across gender cohorts. Further investigation using comparator cohort is warranted. <h3>Reference</h3> [1]The Spondyloarthritis Family | Arthritis Foundation. 2022. The Spondyloarthritis Family | Arthritis Foundation. [ONLINE] Available at: https://www.arthritis.org/diseases/spondyloarthritis [Accessed 23 November 2022] <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.